Sean T Benham MDSC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

33608 020 Issued in WI

Legal business name

SEAN T BENHAM MDSC

Practice address

1765 North 18 Street
Manitowoc, WI 54221-0997

Phone

(920) 482-0575

Fax

(920) 482-0579

NPI assigned

Nov 9, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Betteann Dorothy Radue

Title

Manager

Phone

(920) 482-0575

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tara A. Patridge, APNP

  • Nurse Practitioner
  • Stevens Point, WI
  • NPI 1942465539
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093886434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 997",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542210997",
            "telephone_number": "920-482-0575",
            "fax_number": "920-482-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 NORTH 18 STREET",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542210997",
            "telephone_number": "920-482-0575",
            "fax_number": "920-482-0579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAN T BENHAM MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RADUE",
        "authorized_official_first_name": "BETTEANN",
        "authorized_official_middle_name": "DOROTHY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "920-482-0575",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WI",
            "license": "33608 020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31847300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Leroy Frederick Schultz, MD
• Susan Leslie Schum-Knickelbine, O.T.R., C.H.T.
• Susan Marie Schutz, LICSW CEAP
• Cassandra Ann Schwartz, PTA
• Valerie Scoresese, RN
• Paulette Marie Sears, MS LPC
• William J Seder, DC
• Jerel Sehloff, RPH
• Stephen Robert Seifert, RD,CD
• Select Physical Therapy of Green Bay Limited Partnership

• Surgery Physician in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.